Provider Demographics
NPI:1851509665
Name:ANTONINE SISTERS ADULT DAY CARE, INC.
Entity Type:Organization
Organization Name:ANTONINE SISTERS ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-538-9822
Mailing Address - Street 1:2675 N LIPKEY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9665
Mailing Address - Country:US
Mailing Address - Phone:330-538-9822
Mailing Address - Fax:330-538-9820
Practice Address - Street 1:2675 N LIPKEY RD
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9665
Practice Address - Country:US
Practice Address - Phone:330-538-9822
Practice Address - Fax:330-538-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0840559Medicaid